Ramadan is the month of fasting and prayers for believers of Islam.

  • Fasting is obligatory for all adult, healthy Muslims.
  • During fasting, no food or water intake is permitted from dawn to dusk.

Who all are exempted:

  • Children below the puberty age
  • Mentally incapacitated individuals
  • People with acute illness
  • Chronic illness as diabetes with complications
  • While travelling for distances more than 50 miles
  • Menstruating women
  • Pregnant and breast feeding women

What are the Risks?

Category 1 – Subjects at very high risk – should preferably not fast

  • Episode of severe hypoglycaemia (assistance was needed for recovery) in the last 3 months
  • Recurrent hypoglycaemia
  • Hypoglycaemia unawareness
  • Sustained poor glycaemic control
  • Ketoacidosis in the previous three months
  • Type 1 Diabetes
  • Acute illness
  • Persons performing intense physical labour
  • Pregnancy
  • People on long term dialysis

Category 2 High risk

  • Average blood glucose between 150 – 300 mg/dl
  • Advanced complications as heart disease or paralysis
  • Living alone with treatment with insulin or sulfonylureas
  • Old age needing physical assistance
  • Mentally disabled persons

Category 3 – Moderate risk

  • People with a good blood glucose control on tablets liable to cause hypoglycaemia

Category 4- Low risk

  • People on a diet only
  • Treatment with metformin, acarbose, Tzds or incretin based therapy


What are the risks during fasting:

Hypoglycaemia (Low blood glucose < 60mg/dl)

Hyperglycaemia (High blood glucose > 300 mg/dl

DKA – decompensated diabetes which can be a threat to life

Dehydration and Thrombosis (clotting of blood in the vessels)


Preparation for Ramadan

  • Consult your physician 4 to 6 weeks before the onset of Ramadan
  • Achieve a good blood glucose control by following the recommended diet and adjustment of medication

Self Monitoring of Blood Glucose during fasting

  • 3 hours after the morning meal
  • One hour before Iftar
  • Mid Day for those on insulin or SU
  • Any time if hypo symptoms develop
  • Two to three hours after dinner



Diet in Ramadan:

  • Healthy and Balanced diet
  • Avoid large quantities of food and food rich in fats and refined carbohydrate ( sweets and sugary drinks)
  • Have more of complex carbohydrates specially in the morning meal. Use whole wheat Atta chapattis or cereal.
  • Take the pre-dawn meal as late as possible
  • Do not have the traditional fried food as pakoras and samosas
  • Have the evening meal at time of breaking the fast at sunset.
  • Follow with a snack at bedtime preferably a glass of milk
  • Drink plenty of water during the non-fasting hours.


Strenous exercise should be avoided

Normal routine activity should be continued

Routine prayers and special prayers of Ramadan can be considered as the replacement  of daily exercise


The dosage of your tablets or insulin will be altered by your doctor

Keep the prescription handy for reference and follow the instructions.

If the blood glucose level is unusually high or low consult your doctor.

Rules for Breaking the fast:

  • If Blood glucose level reaches to less than 60mg/dl after noon
  • Blood glucose level is less than 70mg/dl a few hours after the morning meal and medication or insulin has been taken
  • Blood glucose exceeds 300mg/dl
  • Ketones in urine


Type 1 Diabetes and fasting     

Those who should not fast

  • High and unstable blood glucose levels.
  • Hypo unawareness,
  • Inability to perform home monitoring several times daily,
  • Limited access to medical care

Those who may fast

  • Stable patients,
  • Basal Bolus insulin regime is preferable (Short acting insulin before meals and a basal insulin for 24 hours stabilization).



Contributed by:

Dr. Fatema Jawad
Journal of Pakistan Medical Association, Karachi
Past President, PAME (Pakistan Association of Medical Editors)
Past Director WAME ( (World Association of Medical Editors) (2015-2017)
Consultant Diabetologist
Sindh Institute of Urology and Transplantation
Karachi, Palkistan